Healthcare Provider Details

I. General information

NPI: 1982084950
Provider Name (Legal Business Name): OLIVIA SIMPSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S HICKORY ST STE 114
ESCONDIDO CA
92025-4360
US

IV. Provider business mailing address

10729 TIPPECANOE PL
PARRISH FL
34219-2268
US

V. Phone/Fax

Practice location:
  • Phone: 321-945-9159
  • Fax:
Mailing address:
  • Phone: 321-945-9159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108740
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number60919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: